Unsupervised trajectories of respiratory/allergic symptoms throughout childhood in the PARIS cohort
Unsupervised trajectories of respiratory/allergic symptoms throughout childhood in the PARIS cohort
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DOI：
10.1111/pai.13027
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发表时间：
2019-05-01
影响因子：
4.4
通讯作者：
Momas, Isabelle
中科院分区：
文献类型：
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作者：
Bougas, Nicolas;Just, Jocelyne;Momas, Isabelle
背景：儿童时期哮喘、湿疹和过敏性鼻炎的自然病程和共同发生情况仍未完全记录下来。我们的目标是根据学龄儿童呼吸道/过敏症状的时间进程、严重程度和明显的触发因素来识别和描述特征。方法：在巴黎出生队列的随访期间，每年收集哮喘、鼻炎和皮炎症状的发生、严重程度和触发因素的数据。使用多维(同时考虑所有症状)聚类分析将8-9岁之前具有相似症状轨迹的儿童分组。使用Logistic或线性回归模型分析不同症状与不同健康结局之间的关系。结果：确定了6种不同的症状特征。通过与食物和空气变应原过敏相关的持续性皮炎症状来定义特征。有两个特征是喘息：一个是早期短暂性喘息，另一个是持续喘息，与医生诊断的哮喘、呼吸道阻塞和常年性空气变应原致敏有关。鼻炎症状有三个特征：一个不过敏，两个过敏，要么是与过敏性多发病和常年性空气变应原致敏有关的持续性鼻炎症状，要么是与花粉和常年性空气变应原敏化以及低肺功能有关的迟发性症状。结论：本研究进一步深入了解了从出生到学龄的呼吸道/变态反应结局的发育特征。已确定的资料在客观特征方面明显不同，如诊断的发病率、敏感度或肺功能测量，因此突出了它们的生物学和临床相关性。过敏性鼻炎的特征值得特别注意，因为它们很可能涉及多病模式。
Background: Natural course and co-occurrence of asthma, eczema, and allergic rhinitis through childhood are still not fully documented. We aim to identify and characterize profiles based on the time course, severity, and apparent triggers of respiratory/allergy symptoms in school-aged children.Methods: Data on occurrence, severity, and triggers of asthma, rhinitis, and dermatitis symptoms were collected annually during the follow-up of the PARIS birth cohort. Children with similar symptom trajectories until 8-9 years were grouped into profiles using multidimensional (all symptoms considered simultaneously) cluster analysis. Associations between profiles and different health outcomes were analyzed using logistic or linear regression models.Results: Six distinct symptomatic profiles were identified. A profile was defined by persistent dermatitis symptoms, associated with sensitization to food and aeroallergens. Two profiles were characterized by wheezing: one with early transient wheezing and the other with persistent wheezing related to doctor-diagnosed asthma, airway obstruction, and perennial aeroallergen sensitization. Three profiles were characterized by rhinitis symptoms: one non-allergic and two allergic, either with persistent rhinitis symptoms related to allergic multimorbidity and sensitization to perennial aeroallergens, or with late-onset symptoms, related to both pollen and perennial aeroallergens sensitization as well as low lung function.Conclusion: This study brings further insights into the developmental profiles of respiratory/allergic outcomes from birth to school age. The identified profiles clearly differed regarding objective features such as diagnosed morbidity, sensitization, or lung function measurements, thus highlighting their biologic and clinical relevance. Allergic rhinitis profiles deserve particular attention, since they were likely to be involved in multimorbidity patterns.